Meal Provision as a Strategy for Supporting Weight Loss and Improving Metabolic Parameters in Type 2 Diabetes

Presentation

J.L. is a 65-year-old white woman diagnosed with type 2 diabetes at age 62 years. She has struggled with weight gain during her adult years and has repeatedly attempted to lose weight through various popular diets. Nevertheless, her weight continued to increase, and her glycemic control became increasingly erratic. She reports monitoring her blood glucose infrequently because seeing elevated glucose values causes her to feel “out of control” and depressed. She is generally not physically active and has recently been very inactive because of a leg injury resulting from a fall.

At her last physician visit, J.L.'s height was 5′7″, and her weight was 230 lb (BMI 36 kg/m²), her highest adult weight. Her hemoglobin A_1c (A1C) was 7.2% on 1,000 mg of meformin twice daily taken with breakfast and with her evening meal, plus 8 mg of rosiglitazone once daily. Her blood pressure was 126/82 mmHg on 150 mg of irbesartan daily, and her lipid panel showed an LDL cholesterol of 107 mg/dl, HDL cholesterol of 42 mg/dl, and triglycerides 156 mg/dl on 20 mg of rosuvastatin daily.

J.L.'s physician referred her to a registered dietitian, who determined that J.L. was frustrated and overwhelmed with her attempts to follow multiple dietary recommendations and that meal planning was a considerable stressor for her. This contributed to dietary nonadherence. In addition, J.L.'s leg injury made meal preparation difficult.

The dietitian suggested that J.L. try a portion- and nutrient-controlled meal plan that would provide a high degree of structure and support. This option could enable J.L. to experience success with weight loss and help improve her glycemic control and other metabolic parameters. Also, the meals could be used as a …